Overcoming medication refusal using a patient-centered approach

The refusal of psychotropic medication is a challenge faced by many healthcare providers when treating patients with mental illness. Controversy surrounds medication refusal because some mental health professionals believe that psychiatric patients should be forced to take medications for the safety of the general public, while patients are often acutely aware of potential lifelong adverse side effects and are sometimes reluctant to comply. The proposed alternative to this problem begins with developing the patient-provider relationship through a patient-centered approach. This approach emphasizes the individual needs of patients and creates opportunities for input from patients about their care, which helps form relationships of mutual trust and respect between patients and providers. This article explores the literature to: (1) understand some of the challenges and controversies involved in patient medication refusal from a clinical and societal level; (2) identify some issues in a patient-centered approach; and (3) make some brief clinical and policy recommendations that might help to bring about an increase in the use of patient-centered care. Hopefully, as efforts are made toward a patient-centered approach, increased psychotropic medication adherence and decreased medication coercion will result as providers listen and act upon the needs of their patients.     

A Deprivation Analysis for Andalusia (Spain): An Approach Based on Structural Equations

The study of deprivation, as a social indicator, is basic in the design and development of public policies because it allows decision makers to identify and analyse needy areas in order to improve their citizens’ well-being. The methodological approach proposed for the development of a new deprivation index is based on the Causal Theory whose conceptual model is analysed using Structural Equations. The domains selected for the deprivation index are: education, employment, income, housing, infrastructures and health. A structural equation model based on variance is the exploratory method used to obtain the indices pertaining to the above mentioned areas; the results obtained are seen to be quite reliable. There is a positive connection between the areas of education, employment and income while the relations between infrastructures and health are found to be negative. The results can be projected at a local level and show basic territorial deficiencies. The spatial units studied are the Andalusian (south of Spain) municipalities (770). The spatial projection of the indices obtained for the domains of deprivation highlights the existence of geographical areas which could be a potential target for public action.     

Bayesian Treatment of Model Uncertainty for Partially Applicable Models

This article discusses how analyst's or expert's beliefs on the credibility and quality of models can be assessed and incorporated into the uncertainty assessment of an unknown of interest. The proposed methodology is a specialization of the Bayesian framework for the assessment of model uncertainty presented in an earlier paper. This formalism treats models as sources of information in assessing the uncertainty of an unknown, and it allows the use of predictions from multiple models as well as experimental validation data about the models’ performances. In this article, the methodology is extended to incorporate additional types of information about the model, namely, subjective information in terms of credibility of the model and its applicability when it is used outside its intended domain of application. An example in the context of fire risk modeling is also provided.     

Observed and parent‐reported conscience in childhood: Relations with bullying involvement in early primary school

This exploratory study aimed to examine which components of early childhood conscience predicted bullying involvement around school entry. In the population‐based Generation R Study, teacher reports of bullying involvement and parent reports of conscience were available for 3,244 children (M age = 6.7 years). Higher levels of overall conscience predicted lower bullying perpetration scores, independently of intelligence quotient, temperamental traits and sociodemographic characteristics. Particularly, the subscales guilt, confession, and internalized conduct, and to a lesser extent empathy, predicted bullying perpetration. Conscience was not related to victimization. Similar results were found using observations during so‐called ‘cheating games’ (subsample N = 450 children). Findings suggest that improving children's understanding of moral standards and norms may be a potential target for bullying intervention programs in early primary school.     

Impact of Gender Binarism on Hijras’ Life Course and Their Access to Fundamental Human Rights in Pakistan

This study adds to the growing body of knowledge on gender nonconformity aspects of heteronormativity by examining its impact on the life course of hijras and their access to fundamental human rights in Pakistan. Drawing on 50 semistructured interviews conducted in two sites, the findings suggest that the participants’ lived experiences associated with gender nonconformity significantly influenced the direction of their life course and their ability to have access to human rights. These experiences spanned from childhood to elderhood across a wide range of settings, such as family, school, guru dera (residence headed by a hijra guru), workplace, and interactions with authorities. The participants’ human rights were not recognized, resulting in abuse, social stigma, discrimination against them, and their exclusion from mainstream society. Finally, implications are drawn for public policy and future research on third gender concerns in Pakistan and elsewhere.     

A comparative study of social assistance systems in Macao and Hong Kong

This article compares social assistance systems in Macao and Hong Kong. It finds that Macao delivers a higher level of social assistance benefits, whereas Hong Kong has a larger group of social assistance beneficiaries. The Hong Kong Government spends a larger amount on social assistance provision and imposes tougher controls on the recipients, compared to Macao. The results of the comparison indicate that Macao and Hong Kong differ markedly in the type of productivist welfare regime they belong and challenge the assertion that the two welfare systems form a distinct welfare model.     

Exploring the link between integrated leadership and public sector performance

This study develops the concept of integrated leadership in the public sector. Integrated leadership is conceived as the combination of five leadership roles that are performed collectively by employees and managers at different levels of the hierarchy. The leadership roles are task-, relations-, change-, diversity-, and integrity-oriented leadership. Using data from the Federal Human Capital Survey and Program Assessment Rating Tool, we analyze the relationship between integrated leadership and federal program performance. The findings from the empirical analysis indicate that integrated leadership has a positive and sizeable effect on the performance of federal sub-agencies. The study concludes with a discussion of the implications of the findings and limitations of the study.